Well, when the origin of this kind of stress is Pluto, all I can say is "A long time." And when it's placed by transit in the client's first house of Personality, Public Image, and Outward Expression of the psyche, all I can offer is the advice that "Yes, you're hurting--because you're being Transformed, Re-designed, and Rebuilt in ways that you can't yet understand--but the results will be amazing when the process is over. It's the Phoenix Principle all over again--but now you're getting it from up-down-forwards-backwards." It's what I call "Being thrown into the Food Grinder of Life": what comes out is a whole new look of the psyche and someone's physical being as well.
This transit, especially as it's Plutonian, will last for years--and if there's an interception in the first house, MANY years--and possibly for two decades or so. It also impacts (as the first house is an angular house, or area of Major Life Experience and Emphasis), the other three angular houses: the 4th (Home Environment), the 7th (Personal and Business Relationships), and the 10th (Career and Status).
I also consider a Pluto 1st house transit to be the quintessential "metamorphic" energy dynamic. Then again, if one desires diamonds, then there's got to be pressure applied to a lump of coal. In this case, it's the individual client who is now finding him or herself to be made of carbon. Hopefully, he or she will find themselves shining with brilliant value from within and externally as a "new person" when the transit has long passed.
With Pluto in the 1st, into the grinder of Transformation, Change, Regeneration, Rebuilding, and Reconstruction we—or you--go! The way you feel about yourself, and the image you project to the outer world will change radically. Your need to be in control of yourself and of your environment will also change, and you may find that your lifestyle alters considerably under this transit.
I would think of this transit as being caught in a vise, or slowly sanding off the rough edges on a huge carved statue—this definitely impacts the physical form; the body (human, or redesigning a corporate image if this is a business entity—a logo modification or new design?). What the world perceives about us is transformed as our appearance undergoes a change.
Plastic surgery, having growths removed, applying artistic designs such as tattoos—and mental endeavors such as adapting a new persona and way of presenting oneself are potential 1st house Pluto activities. This is also a time when ‘animal magnetism’ and sexual energy becomes stronger because Pluto will enhance a sense of radiant power. No matter how it personally is internalized, on an outward manifestation, a 1st house Pluto transit will “remodel” the receiver in some long-term fashion or manner. An awareness of dynamic potential surrounds the individual like an aura. I like to think of the caterpillar shedding its skin, or even snakes—and they’re Plutonian for that reason.
This gives greater control over unconscious drives that have instigated compulsions and irrational impulses. An individual will gradually become aware of the circumstances that have shaped him or herself. As noted above, personality traits are more in line and there is greater opportunity to “remake” one’s image. Actors or actresses who take on new and different roles would be a good visual image. Physical practices may be undertaken to transform the body, such as yoga, Tai Chi, Pilates, or other movement forms. Reiki sessions, massage, shiatsu, and Jin Shin Jyutsu are excellent therapies to consider.
Power trips and control can become more open and noticeable during a Pluto-1st transit regarding your personality and how you approach the world. The possibilities for change are open: the choices are for greater or lesser, for better or worse.